Radiant Skin Dermatology and Laser,PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

256265 Issued in NY

Legal business name

RADIANT SKIN DERMATOLOGY AND LASER,PLLC

Practice address

207 W 115TH St Lowr Level
New York, NY 10026-2965

Phone

(212) 229-0007

Fax

(347) 274-8349

NPI assigned

Dec 31, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Adebola Olufunmi Dele-Michael, MDNPI 1235250820

Title

Owner

Phone

(212) 229-0007

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Adebola Dele-Michael, M.D

  • Dermatology Physician
  • New York, NY
  • NPI 1235250820
  Medicare reassignment Authorized official
• Abiola Olayemi Dele-Michael, MD

  • Cardiovascular Disease Physician
  • New York, NY
  • NPI 1518084664
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1356912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709510400000",
    "number": "1861738460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "234 CENTRAL PARK W",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100246003",
            "telephone_number": "212-229-0007",
            "fax_number": "212-202-6350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 W 115TH ST LOWR LEVEL",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100262965",
            "telephone_number": "212-229-0007",
            "fax_number": "347-274-8349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIANT SKIN DERMATOLOGY AND LASER,PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-31",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A",
        "authorized_official_last_name": "DELE-MICHAEL",
        "authorized_official_first_name": "ADEBOLA",
        "authorized_official_middle_name": "OLUFUNMI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "212-229-0007",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "NY",
            "license": "256265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jai Radhakrishnan, M.D.
• Jolly Radhakrishnan, MD
• Farhan Radhanpuri, PT
• Radial Health Florida, P.a.
• Radiant Prep, LLC
• Radiantcare
• Radiation Oncology Medical Practice of St Vincents PC
• Radiation Oncology Medical Practice of St. Vincents, PC
• Elisa L Radice, M.S.
• Danielle Radigan, LMHC

• Dermatology Physician in New York, NY
• Providers in New York, NY by specialty
• Dermatology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.